How to manage diarrhea during chemotherapy - PfizerPro

For patients and those who care for them...How to manage diarrhea during chemotherapyDid you know?• Diarrhea caused by chemotherapy (or “chemo”) can be serious and threaten your life• It might not go away on its own• It might get worse without the right treatment• It can prevent your body from keeping the liquids you drink and from fully digesting your food• It can cause a blood infectionSigns that you may have diarrhea• More bowel movements than you had before you started chemo(if you are not sure what is normal, keep a daily record; see the chart below)• Softer, looser, or more watery bowel movements• More cramps, gas, or stomach pain2 kinds of diarrheaEarly diarrhea may happen in the first 24 hours after you receiveCAMPTOSAR ® (irinotecan HCl injection). In most cases,it is mild. You may be given medicines before or aftertreatment with CAMPTOSAR to help with these problems.Late diarrhea may happen more than 24 hours after yourtreatment with CAMPTOSAR. Late diarrhea can be moreserious. It can threaten your life if it is not managed well.Do not ignore early or late diarrhea. If left untreated, diarrhea can become serious enough to threaten your life.Be sure to call your Cancer Care Team if you have diarrhea.What to drink if you have diarrhea• Drink at least 6 to 8 large glasses of liquids a day• Drink a little at a time, as often as you can. Water,clear soup, and broth are all goodWhat to eatEat small meals often; think “BRAT”B—BananasR—Rice (white)A—ApplesauceT—Toast (white)If you do well on these foods, you can start adding others:• Bland, low-fiber foods• Skinless chicken or turkey baked on broiler pan in oven• Crackers, white bread, or spaghetti with unseasoned tomato sauce• Peaches and pears canned in juice—not in syrupWhat not to drink• Don’t drink milk• Avoid very hot or• Avoid alcohol and caffeine very cold drinks(coffee, tea, most colas) • Avoid prune juiceWhat not to eatThese foods can make diarrhea and cramping worse:• Raw meat and fish• Raw fruits and vegetables• Fatty, fried, spicy, sweet, or rich foods• Whole grains• Dried beans• Popcorn• ChocolateCheck your bowel movements. It is important to know what your normal stool is like. It can help you see how your treatmentaffects you. Fill in the chart below, starting 1 week before your treatment. Be sure to make an entry each time you have a bowel movement.Fill in the time of day and check the box or boxes that best describe your bowel movement. One day is filled in to show you how.Date:11/24/0611/24/0611/24/06Time:8:15 a.m.11:25 a.m.2:30 p.m.Hard?✔✔Formed?Soft?Loose?✔Watery?See other side to learn how to treat diarrhea

Taking medicine for diarrheaYour doctor may suggest that you take a medicinecalled Imodium A-D. It is also called loperamide HCl.You might want to have some on hand before yourtreatment starts.• Be sure to take the medicine just as your Cancer CareTeam tells you to. Your Team will tell you the rightdose for bowel problems caused by chemo• During the night, you still have to take 2 capletsevery 4 hours. Don’t stop taking it until you havenot had any bowel movement for at least 12 hours• If you get a fever (over 100.4°F) or feel sick, callyour Cancer Care Team right away• Keep track of how many bowel movements youhave. If you still have diarrhea 24 hours after takingImodium A-D, call your Cancer Care Team right awayOther signs to tell your Cancer Care Team about• Dry mouth• Darker urine, less urine, or both• Weight loss• Feeling tired or weakTaking Imodium ®A-D for late diarrheaBe sure to follow the dosing directions below.They are for people taking CAMPTOSAR.Do not follow the directions on the Imodium A-D package.First Dose:Duringthe Day:Duringthe Night:IMODIUMA-DIMODIUMA-DIMODIUMA-DIMODIUMA-DIMODIUMA-DTake 2 caplets (4 mg) of Imodium A-DTake 1 caplet (2 mg) every 2 hoursTake 2 caplets (4 mg) at bedtime and 2 capletsevery 4 hours until morning. You must set youralarm clock to wake you up during the night soyou can take your Imodium A-DStop taking Imodium A-D when you have not hadany bowel movement for 12 hours. Do not takeImodium A-D for more than 48 hours (2 days)Be sure to tell your Cancer Care Team right awayif you have any of these signs• Fever (temperature above 100.4ºF) or shaking chills• Feeling cold• Bad stomach pain or cramps• Feeling woozy, dizzy, or faint• Black or bloody bowel movementsCAMPTOSAR is approved to treat cancer of the colon or rectum that has spread to other parts of the body.It can be used along with 2 drugs, called 5-FU and LV. 5-FU stands for fluorouracil. LV stands for leucovorin.CAMPTOSAR can also be used when the cancer has come back or grown worse after treatment with 5-FU.Important safety informationTaking CAMPTOSAR may cause “early” and “late” diarrhea. Both of them can threaten your life. Late diarrhea should betreated right away with a medicine called Imodium A-D. You may also need to take an antibiotic.CAMPTOSAR can also decrease your number of white blood cells. This may be treated by a delaying or lowering of the dose.You can also take a protein that helps produce healthy blood cells.Some people should be watched closely by their doctors while taking CAMPTOSAR. They include those who:• Are over age 65• Have received radiation in the pelvis or stomach• Have trouble carrying out daily tasks due to their cancerIn rare cases, blocked bowel, colon problems, or liver disease has occurred with CAMPTOSAR.To help prevent nausea and vomiting, you may be given other drugs before taking CAMPTOSAR. You may also be givena drug called atropine. It will help you fight side effects such as diarrhea.In some cases, CAMPTOSAR may cause problems with your heart and blood vessels, including blood clots. Doctors do notknow for sure why this happens.You should not take CAMPTOSAR if you have severe bone marrow failure.You should also not take it if you react poorly to fruit sugar. That is because CAMPTOSAR contains a kind of fruit sugarcalled sorbitol.Imodium A-D is a registered trademark of McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil PPC, Inc.Patient information provided as a service by Pfizer Oncology.Please see enclosed product information for CAMPTOSAR, including black box warning. You may also visit www.pfizeroncology.comto view the product information.CQ279693 © 2006 Pfizer Inc. All rights reserved. Printed in USA/November 2006